Metabolic Syndrome is usually a stage that happens before having Type 2 Diabetes, however it can be avoided if changes are made to a person’s diet and lifestyle early enough. Metabolic Syndrome is sometimes referred to as a form of pre-diabetes. Some of the symptoms include putting on weight, especially holding fat around the abdominal area (apple shape), craving sweet foods and refined carbohydrates, cold spells, irritability and tiredness [1].

Metabolic Syndrome stems from an inappropriate, unbalanced diet, where a person usually constantly eats foods that are high in sugar, whether natural or refined, such as refined carbohydrates, breads- white flours, cakes, refined sugars, sweets, alcoholic beverages, or sweetened drinks, etc. Usually someone with this condition is deficient in micronutrients. A lack of exercise and sedentary lifestyle also contributes.

Typically, a person may be diagnosed with Metabolic Syndrome if they have three or more of these factors: large waist size (waist circumference greater than 90cm for men and greater than 85cm for women), triglyceride levels higher than 150mg/dl, low HDL (high density lipoprotein – “good cholesterol”) levels, high blood pressure, and fasting blood sugar levels of over 100 mg/dl. It is also characterised by insulin resistance and a difficultly handling glucose [6]. The presence of Microalbuminuria (a marker for inflammation and used to describe a moderate increase in the level of urine albumin), may also be an indicator of this syndrome, where protein is excreted in the urine, and with abnormalities in blood clotting, blood flow and blood vessel structure.

Preceding Metabolic Syndrome can be Reactive Hypoglycaemia (postprandial hypoglycaemia), where a person has (usually repetitively) consumes an excess intake of simple carbohydrates (as mentioned above) and/or a lack of proteins and good fats to balance them, and then experiences highs and lows of their blood sugar/energy levels. Basically, simple carbohydrates are ‘fast releasing’ carbohydrates, which mean the food coverts to glucose very quickly. Simple carbohydrates include more than monosaccharides and disaccharides (which technically are simple sugars). Monosaccharides include glucose, fructose and galactose. These can be absorbed directly and don’t require further breakdown from enzymes, unlike disaccharides and polysaccharides (two or more units of sugars).

When we consume simple carbohydrates such as white sugar and white flour based foods (and in general low glycaemic index meals), they breakdown quickly causing a fast spike in blood sugar. This excess of glucose in the blood then over-stimulates an insulin release, clearing blood glucose very fast which leads to low blood sugar levels (hypoglycaemia) and with it a quick drop in energy levels. This then triggers an adrenalin response to bring the blood sugar levels up to normal values. Also of note, is that when the body is unable to use up this excess of energy, it will then convert it and store it as fat in the body (where excess fat especially around the body is an indicator for being insulin resistant).

Stress can also create reactive hypoglycaemia because when we are stressed, our adrenals release a fight or flight hormone ‘cortisol’ (a corticosteroid hormone) which plays a key part in blood sugar regulation (both adrenaline and cortisol are released during the stress response – adrenaline first, cortisol in prolonged stress). Some cortisol is actually okay for us as it taps into protein stores via gluconeogenesis in the liver, to give us a spurt of energy when we need it, however too much cortisol caused by regular bouts of stress consistently produce more energy and in the form of glucose. In turn this leads to elevated glucose levels which triggers the same blood sugar cycle as it does for simple carbohydrates.[2] Adrenaline is also released as a “fight or flight” hormone (also a neurotransmitter and a catecholamine) and has the same effect of releasing stored glycogen to create energy. As for cortisol, too much can create elevated glucose levels.

Symptoms of Reactive Hypoglycaemia include fatigue, mood swings, inability to cope with stress, poor concentration and memory [3] and unless this Reactive Hypoglycaemia is controlled, it can lead to Insulin Resistance and Metabolic Syndrome, as well as type 2 Diabetes later.

The thyroid too partakes in blood sugar metabolism and dictates the efficiency of the liver function. Sometimes an under-active thyroid, or stress (which can physically constrict the liver and also lower HCL levels), can also be at the root of hypoglycaemia (low blood sugar levels).

However, rather than Metabolic Syndrome being total adiposity (the state of being obese), the core clinical component of the syndrome is visceral and/or ectopic fat (i.e., fat in organs not designed for fat storage) whereas the principal metabolic abnormality is insulin resistance (see below). The continuous provision of energy via dietary carbohydrate, lipid, and protein fuels, unmatched by physical activity/energy demand, creates a backlog of the products of mitochondrial oxidation, a process associated with progressive mitochondrial (the powerhouse of cells) dysfunction and insulin resistance [4].

As mentioned previously, a characteristic of with Metabolic Syndrome is for a person also to have Insulin resistance (IR), which is a physiological condition, in which cells (muscle, fat, liver) fail to respond to the normal actions of the hormone insulin. The body produces insulin, but the cells in the body become resistant to insulin and are unable to use it as effectively, leading to hyperglycaemia (and ketosis –a condition in which levels of ketones (ketone bodies) in the blood are elevated). The body thus needs an increased amount of insulin daily to control the hyperglycaemia. Beta cells in the pancreas subsequently increase their production of insulin, further contributing to hyperinsulinemia [5](meaning the amount of insulin in the blood is higher than considered normal amongst the non-diabetics, and that the body is still struggling to control the blood sugar). The pancreas then gets exhausted and cannot secrete the insulin required to maintain normal blood glucose levels and this results in excess glucose building up in the blood. Insulin resistance occurs possibly due to changes in the shape of the insulin receptor, or to changes in the way cells respond to insulin itself. The excess glucose then deposits as belly fat (helped by the insulin agent), which is typical in those with Metabolic Syndrome. Other conditions due to insulin resistance can result, such as osteoporosis (excess insulin production impairs the synthesis of DHEA hormone, and also after the menopause this is the only source of oestrogen), and age-related disorders.

Those diagnosed with Metabolic Syndrome (and sometimes called syndrome X) not only have the chance of to leading to type 2 Diabetes but are also subject to an increase risk of coronary heart disease (plaque building up along the inner walls of the arteries of the heart, which narrows the lumen of arteries and reduces blood flow to the heart) and stroke. This risk is three times greater than it would be for someone with a normal glucose level. This could be due to the person with Metabolic Syndrome being overweight/obese. Someone with Metabolic Syndrome have been linked to having impaired myocardial mitochondrial biogenesis, fatty acid metabolism, and antioxidant defence mechanisms lead to diminished cardiac substrate flexibility, decreased cardiac energetic efficiency, and diastolic dysfunction.[7].

Diet and lifestyle changes are what can turn this condition around, and initial step would be to reduce the amount of carbohydrates that are fast digesting starches and sugars, balance the composition of dietary fats, and reduce sugar intake [8]. Balancing this with an increase in fruit and vegetables in their diet (recent studies mention that higher protein and low carb diets work well in Metabolic Syndrome [9]) as well as increasing their physical exercise levels would certainly improve their health status, and therefore reducing their chances of other more serious conditions developing.

In addition, healing a leaky gut and inflammation, taking a probiotic supplement (containing bifidobacteria and lactobacilli), eating bitter melon (researched as helping to stabilise blood sugar levels), and taking a blood sugar support supplement [10] may also help someone heal.

Additional: Research is still being carried out in the benefits of a probiotic in Metabolic syndrome and other metabolic disorders, however on a study carried out at the National Institute of Health & Medical Research in Toulouse, France stated that, “the probiotic (B420) treatment reduced the fasted insulin levels, but improved the insulin secretion upon glucose challenge, indicating an improved metabolic flexibility and restoration of normal glucose metabolism, and a potential beneficial effect on metabolic syndrome,”. The research also added that the beneficial effect of B420 is mediated by a reduction of the pro-inflammatory molecule, plasma lipopolysaccharide (LPS). “B420 changes intestinal mucosal microbiota and reduces the efflux of LPS into plasma, thereby reducing inflammation and improving insulin metabolism,” [11]